Intraoperative parathyroid hormone monitoring in parathyroidectomy: Predicting cure and recurrence in tertiary hyperparathyroidism - systematic review

Abstract

Objective: The aim of this systematic review was to investigate the value of intraoperative parathyroid hormone (IOPTH) monitoring in parathyroidectomy for tertiary hyperparathyroidism (THPT) to predict cure and recurrence.

Data sources: Ovid, Embase, EBSCO Host, Citation Checking.

Methods: This study was performed in accordance with PRISMA guidelines. A systematic search of the literature was conducted to identify studies evaluating IOPTH monitoring in patients with THPT. Only studies addressing THPT with documented use of IOPTH in their surgery were included.

Results: In 11 of the 18 studies included in this review IOPTH monitoring influenced the surgery by identifying insufficient resection or ectopic/supernumerary glands necessitating further resection to cure patients. Rates of recurrence were absent or minimal in patients who achieved appropriate IOPTH drops at specified time intervals.

Conclusion: IOPTH monitoring is a useful adjunct to prevent insufficient resection of hyperplastic glands and to identify ectopic/supernumerary glands. Median PTH drop at specified time intervals can help predict cure and recurrence in parathyroidectomy for THPT.

Keywords: IOPTH; Intraoperative; PTH; Parathyroid hormone; Parathyroidectomy; Tertiary hyperparathyroidism.